title: Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation: a randomized, controlled trial.
abstract: BACKGROUND
  The risks and benefits of long-term dual antiplatelet therapy remain unclear.
  
  
  RESULTS
  This prospective, multicenter, open-label, randomized comparison trial was conducted in 24 clinical centers in Korea. In total, 5045 patients who received drug-eluting stents and were free of major adverse cardiovascular events and major bleeding for at least 12 months after stent placement were enrolled between July 2007 and July 2011. Patients were randomized to receive aspirin alone (n=2514) or clopidogrel plus aspirin (n=2531). The primary end point was a composite of death resulting from cardiac causes, myocardial infarction, or stroke 24 months after randomization. At 24 months, the primary end point occurred in 57 aspirin-alone group patients (2.4%) and 61 dual-therapy group patients (2.6%; hazard ratio, 0.94; 95% confidence interval, 0.66-1.35; P=0.75). The 2 groups did not differ significantly in terms of the individual risks of death resulting from any cause, myocardial infarction, stent thrombosis, or stroke. Major bleeding occurred in 24 (1.1%) and 34 (1.4%) of the aspirin-alone group and dual-therapy group patients, respectively (hazard ratio, 0.71; 95% confidence interval, 0.42-1.20; P=0.20).
  
  
  CONCLUSIONS
  Among patients who were on 12-month dual antiplatelet therapy without complications, an additional 24 months of dual antiplatelet therapy versus aspirin alone did not reduce the risk of the composite end point of death from cardiac causes, myocardial infarction, or stroke.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT01186146.
authors.affiliation: From The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul (C.W.L., J.-M.A., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.); Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul (S.H.); Ulsan University Hospital, Ulsan (S.-G.L.); Chungnam National University Hospital, Daejeon (I.-W. Seong); Korea University Guro Hospitals, Seoul (S.-W.R.); Chonnam National University Hospital, Gwangju (M.-H.J.); Korea University Anam Hospitals, Seoul (D.-S.L.); Yonsei University Wonju College of Medicine, Wonju Christian Hospital, Wonju (J.-H.Y.); Keimyung University Dongsan Medical Center, Daegu (S.-H.H.); Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul (Y.-S.C.); National Health Insurance Corp, Ilsan Hospital, Ilsan (J.-Y.Y.); Soon Chun Hyang University Hospital Bucheon, Bucheon (N.-H.L.); Hallym University Sacred Heart Hospital, Anyang (H.-S.K.); Kangwon National University Hospital, Chuncheon (B.-K.L.); Daegu Catholic University Medical Center, Daegu (K.-S.K.); Kwangju Christian Hospital, Kwangju (S.-U.L.); Chonbuk National University Hospital, Jeonju (J.-K.C.); GangNeung Asan Medical Center, Gangneung (S.-S.C.); Sam Anyang Hospital, Anyang (I.-W. Suh); Kyungpook National University Hospital, Daegu (H.-S.P.); Dongguk University Gyeongju Hospital, Gyeongju (D.-Y.N.); Catholic University of Korea, Incheon St. Mary's Hospital, Incheon (D.-S.J.); Catholic University of Korea, Seoul St. Mary's Hospital, Seoul (K.-B.S.); Veterans Hospital Service Medical Center, Seoul (K.L.); and Inje University College of Medicine, Busan Paik Hospital, Busan (J.-S.J.), South Korea.
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Seungbong
authors.initials: S
authors.lastname: Han
authors.forename: Sang-Gon
authors.initials: SG
authors.lastname: Lee
authors.forename: In-Whan
authors.initials: IW
authors.lastname: Seong
authors.forename: Seung-Woon
authors.initials: SW
authors.lastname: Rha
authors.forename: Myung-Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Do-Sun
authors.initials: DS
authors.lastname: Lim
authors.forename: Jung-Han
authors.initials: JH
authors.lastname: Yoon
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Hur
authors.forename: Yun-Seok
authors.initials: YS
authors.lastname: Choi
authors.forename: Joo-Young
authors.initials: JY
authors.lastname: Yang
authors.forename: Nae-Hee
authors.initials: NH
authors.lastname: Lee
authors.forename: Hyun-Sook
authors.initials: HS
authors.lastname: Kim
authors.forename: Bong-Ki
authors.initials: BK
authors.lastname: Lee
authors.forename: Kee-Sik
authors.initials: KS
authors.lastname: Kim
authors.forename: Seung-Uk
authors.initials: SU
authors.lastname: Lee
authors.forename: Jei-Keon
authors.initials: JK
authors.lastname: Chae
authors.forename: Sang-Sig
authors.initials: SS
authors.lastname: Cheong
authors.forename: Il-Woo
authors.initials: IW
authors.lastname: Suh
authors.forename: Hun-Sik
authors.initials: HS
authors.lastname: Park
authors.forename: Deuk-Young
authors.initials: DY
authors.lastname: Nah
authors.forename: Doo-Soo
authors.initials: DS
authors.lastname: Jeon
authors.forename: Ki-Bae
authors.initials: KB
authors.lastname: Seung
authors.forename: Keun
authors.initials: K
authors.lastname: Lee
authors.forename: Jae-Sik
authors.initials: JS
authors.lastname: Jang
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D000077144:Clopidogrel; D003131:Combined Modality Therapy; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: aspirin; clopidogrel; coronary disease; stents